CobRa COVERAGE

COBRA CONTINUATION OF COVERAGE

COBRA continuation coverage is a continuation of Fund coverage when coverage would otherwise end because of a life event known as a “qualifying event.”  Specific qualifying events are listed later in this notice.  COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.”  A qualified beneficiary is someone who will lose coverage under the Fund because of a qualifying event.  Depending on the type of qualifying event, employees, spouses of employees, and dependent children of employees may be qualified beneficiaries.  Under the Fund, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.   You or your dependents will be required to pay the necessary premium for the following benefits:

• Dental Benefit Plan

• Vision Care Benefit Plan

• Excess Major Medical Benefit Plan

If you are an employee, you will become a qualified beneficiary if you will lose your coverage under the Fund because either one of the following qualifying events happens:

• Your hours of employment are reduced, or

• Your employment ends for any reason other than your gross misconduct

If you are the spouse of an employee, you will become a qualified beneficiary if you will lose your coverage under the Fund because any of the following qualifying events happens:

• Your spouse dies;

• Your spouse’s hours of employment are reduced;

• Your spouse’s employment ends for any reason other than his or her gross misconduct; or

• You become divorced or legally separated from your spouse.

Your dependent children will become qualified beneficiaries if they will lose coverage under the Fund because any of the following qualifying events happens:

• The parent/ employee dies;

• The parent/ employee’s hours of employment are reduced;

• The parent/ employee’s employment ends for any reason other than his or her gross misconduct; or

• The parents become divorced or legally separated; or

• The child stops being eligible for coverage under the Fund as a “dependent child.”

When the qualifying event is the end of employment or reduction of the employment or reduction of the employee’s hours of employment, COBRA continuation coverage lasts for up to 18 months.  There are two ways in which this 18-month period of COBRA continuation coverage can be extended:

1. Disability Extension of 18 month Period of Continuation Coverage:

If you or anyone in your family covered under the Fund is determined by the Social Security Administration to be disabled at any time during the first 60 days of COBRA continuation coverage, and you notify the Fund’s Third-Party Administrator in a timely fashion, you and your entire family can receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months.  You must make sure that the Fund is notified of the Social Security Administrator’s determination by sending a copy of the Determination letter within 60 days of the date of the determination and before the end of the 18-month period of COBRA continuation coverage.  This notice should be sent to the Fund’s Third-Party Administrator.

2. Second Qualifying Event Extension of 18-month Period Continuation Coverage

If your family experiences another qualifying event while receiving COBRA continuation coverage, the spouse and dependent children in your family can get additional months of COBRA continuation coverage, up to a maximum of 36 months.  This extension is available to the spouse and dependent children if the former employee dies or gets divorced or legally separated.  The extension is also available to a dependent child when that child stops being eligible under the Fund as a dependent child.  In all of these cases, you must make sure that the Fund is notified of the second qualifying event within 60 days of the second qualifying event.  This notice must be sent to the Fund’s Third-Party Administrator.  In the event of death, a copy of the death certificate must be provided.  In the event of divorce, you must send a copy of the divorce judgment.  In the event of legal separation, you must send a copy of the Court Order of Separation.

Keep the Fund Informed of Address Changes

In order to protect your family’s rights, you should keep the Fund’s Third Party Administrator informed of any changes in the addresses of family members.  You should also keep a copy, for your records, of any notices you send to the Fund.